Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
KevinMD
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking
KevinMD
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking
  • About KevinMD | Kevin Pho, MD
  • Be heard on social media’s leading physician voice
  • Contact Kevin
  • Discounted enhanced author page
  • DMCA Policy
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • Group vs. individual disability insurance for doctors: pros and cons
  • KevinMD influencer opportunities
  • Opinion and commentary by KevinMD
  • Physician burnout speakers to keynote your conference
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Privacy Policy
  • Recommended services by KevinMD
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The biggest mistake doctors make when purchasing disability insurance
  • The doctor’s guide to disability insurance: short-term vs. long-term
  • The KevinMD ToolKit
  • Upgrade to the KevinMD enhanced author page
  • Why own-occupation disability insurance is a must for doctors

The stoic cure for modern anxiety

Osmund Agbo, MD
Physician
October 7, 2025
Share
Tweet
Share

Our one and only daughter has gone off to college. My wife and I dropped her off the weekend before. As we made the four-hour drive from Houston to Baton Rouge along I-10, the road stretched ahead, both endless and fleeting, as if time itself were torn between holding on and letting go. Between bursts of laughter and quiet silences, we spoke of classes, friendships, boys, the discipline of focus, and, most importantly, the questions that shape a life, namely: the “whys” she must never forget. Every word, every pause, was filled with the kind of love parents hope will echo in a child’s heart long after they are gone. We tried to hide the ache of knowing she was no longer entirely ours.

Though it is barely two weeks since she left, my wife is already unraveling. She worries about everything under the sun; what Nkechi eats, whether she is safe, if she is truly happy. She insists she should never take an Uber alone, only with friends, because the world can be unkind, and mothers, as if by instinct, always imagine the worst.

I like to think I am handling it a little better, but that is only half true. My worries are quieter, perhaps, but they linger all the same. And the irony is not lost on me: the fact that she has always been such a good kid, responsible, grounded, never giving us reason to lose sleep, has done little to ease the weight of our imagination running wild. The human mind, I have found, is endlessly creative in fabricating disasters where none exist.

As humans, it is striking how we conjure entire catastrophic scenarios out of uncertainty. An email from the boss with the subject line “See me” feels like a summons to doom. A delayed call from a spouse morphs into betrayal. A mild headache becomes the seed of a brain tumor in our imagination. And so, long before anything real has happened, we have already lived through the suffering.

Seneca, the stoic philosopher of Ancient Rome, captured this human folly almost two millennia ago when he observed: “We suffer more often in imagination than in reality.” Pain in reality is bounded, finite, and tangible. Fear in imagination is infinite, merciless, and without borders. Michel de Montaigne, centuries later, echoed the same truth: “My life has been filled with terrible misfortunes, most of which never happened.”

As an intensivist working with the very sick, I can testify that Seneca’s wisdom plays out daily at the bedside. It is not always the illness itself that consumes the sick, but the anticipation of it. I have seen patients scheduled for surgery tormented by the night before, unable to sleep, gripped by the fear that they may not make it through. Yet once the operation is done, and the tubes and machines are withdrawn, many discover that the suffering of anticipation was far worse than the ordeal itself.

Families, too, live through this cycle: they suffer the loss of loved ones many times in their imagination before the actual moment arrives. And when it does, when reality finally demands its share, they often find that it is bearable, even infused with moments of grace, solidarity, and unexpected courage.

One of my most important duties as a doctor, beyond prescribing medications and adjusting ventilators, is helping patients and families disentangle real suffering from imagined suffering. To remind them, sometimes gently and sometimes firmly, that they need not die a thousand deaths in their minds before reality arrives.

History offers further confirmation of this truth. During the major German bombing campaign against the United Kingdom in World War II, popularly known as the London Blitz, psychologists observed that the anticipation of bombings often created greater anxiety than the bombings themselves. Once the sirens stopped and the bombs fell, people adapted, found courage, and built community amid the rubble. Reality had boundaries; imagination had none.

And it is not just in war or illness. In everyday life, we experience the same dynamic. How many tasks have we procrastinated on because we imagined they would be unbearable, only to discover, once begun, that they were manageable, even easy? How many conversations have we avoided because we pictured them spiraling into conflict, only to find, in reality, that honesty brought relief?

Again and again, the dread proves worse than the deed.

The problem is even magnified in our digital age. Every headline predicting collapse, every social media feed amplifying disaster, every algorithm pushing sensational fear stories keeps us in cycles of imagined suffering. We doomscroll our way into panic, prisoners of “what if,” sacrificing the present to a future that may never arrive.

The tragedy is that imagined suffering is not harmless. Chronic anxiety triggers cascades of stress hormones, raising blood pressure, impairing sleep, weakening immunity. Our bodies pay interest on emotional debts we do not owe. We rehearse pain, and in doing so, we harm ourselves twice: once in anticipation, and once if it comes, in reality.

None of this is to deny the legitimacy of suffering. Illness, loss, betrayal, and failure are all part of the human condition. But when they arrive, they arrive clothed in the particular, not in the boundless infinity of our imagination. Reality, no matter how brutal, often brings with it surprising gifts: resilience we never knew we had, compassion from others, and the discovery of meaning even in pain. I have seen patients facing terminal illness with dignity, families rallying around loved ones, communities rising from tragedy with solidarity and courage. In these moments, reality turned out far kinder than the imagination that preceded it. For reality, unlike fear, comes not only with pain but with the possibility of grace.

The question becomes, how do we resist the tyranny of imagination? We cannot silence it altogether, but we can refuse to be its prisoner. We can name our fears and write them down, often discovering their absurdity on paper. We can anchor ourselves in the present, paying attention to what is actually happening rather than what might happen. We can test our fears against evidence, asking: What do I truly know, and what am I assuming? We can recall the resilience we have shown in the past, trusting that we will rise again. And above all, we can refuse to suffer twice. When hardship comes, it will demand its share, let us not pay it in advance.

Seneca’s’ wisdom remains revolutionary because it cuts across centuries and cultures. We suffer more in imagination than in reality, and reality, for all its sharp edges, often proves kinder than we fear. My wife and I must learn this lesson as we watch our daughter begin her journey into the world and navigate life on her own terms. We must not live through our funeral before our death. Life is already difficult; it does not need the added weight of rehearsed tragedies. I just finished reading a memoir by Femi Otedola, one of Nigeria’s wealthiest men, and in it he shared a reflection that has stayed with me. Paraphrasing his words: There is a time to be born and a time to die, but in between, we must learn how to live. To truly live, requires us to resist the tyranny of imagination; the endless rehearsals of suffering that never comes, the fears that rob us of the moment we are standing in. It is the art of inhabiting the present without dying a thousand little deaths before the final one. For the secret of a life well lived is not in banishing fear altogether, but to suffer only what is real.

Osmund Agbo is a pulmonary physician.

Prev

Obesity is the infant of time poverty

October 7, 2025 Kevin 1
…
Next

The mental health workforce is collapsing

October 7, 2025 Kevin 1
…

Tagged as: Psychiatry

< Previous Post
Obesity is the infant of time poverty
Next Post >
The mental health workforce is collapsing

ADVERTISEMENT

More by Osmund Agbo, MD

  • Why billionaires dress like college students

    Osmund Agbo, MD
  • Why embracing imperfection makes you truly unforgettable

    Osmund Agbo, MD
  • How truth depends on where you stand and what you see

    Osmund Agbo, MD

Related Posts

  • Social media: Striking a balance for physicians and parents

    Dawn Baker, MD
  • The hidden financial burdens shaping modern medicine

    Sarah Fashakin
  • 7 proven strategies to beat test anxiety and ace the USMLE

    Brett Doliner, MD and Alyssa Ehrlich, MD
  • Chronic health issues and homelessness

    Michele Luckenbaugh
  • Medical school and the science of sleep

    Sarah Murad
  • How drugmakers manipulate your health from diagnosis to prescription

    Martha Rosenberg

More in Physician

  • Independent medical practice: Why private clinics are essential

    Marcelo Hochman, MD
  • How hindsight bias distorts clinical medicine

    Olumuyiwa Bamgbade, MD
  • Do no harm: Why physician burnout requires bottom-up reform

    Desiree Francis, MD
  • Institutional distrust in health care: Why a doctor lost faith

    Joshua Mirrer, MD
  • Debunking 4 myths about fertility treatments for women of color

    Ilana Ressler, MD
  • Whole-body MRI screening: a radiologist’s guide to preventive scans

    Amit Newatia, MD
  • Most Popular

  • Past Week

    • Politics and fear have replaced science in U.S. pain management [PODCAST]

      The Podcast by KevinMD | Podcast
    • Evidence-based medicine vs. clinical judgment: a medical student’s perspective

      Jay Pendyala | Education
    • The controversy over Maintenance of Certification for grandfathered physicians

      Bernard Leo Remakus, MD | Physician
    • How hindsight bias distorts clinical medicine

      Olumuyiwa Bamgbade, MD | Physician
    • When side effects are actually a cry for help with medication costs

      Shuchita Gupta, MD | Physician
    • The hidden math behind physician hiring costs and recruitment

      Timothy Lesaca, MD | Physician
  • Past 6 Months

    • The dangers of vertical integration in health care

      Stephanie Waggel, MD | Policy
    • Why does sex work seem like a more viable path than medicine in 2026?

      Corina Fratila, MD | Physician
    • The 9 laws of health care quality: Why metrics miss the point

      Constantine Ioannou, MD | Physician
    • Politics and fear have replaced science in U.S. pain management [PODCAST]

      The Podcast by KevinMD | Podcast
    • From Singapore to Canada: a blueprint for primary care transformation

      Ivy Oandasan, MD | Policy
    • How board certification fuels the physician shortage crisis

      Brian Hudes, MD | Physician
  • Recent Posts

    • Why measuring muscle mass matters more than tracking your weight [PODCAST]

      The Podcast by KevinMD | Podcast
    • Health insurance incentives and alternatives to opioids for chronic pain

      Molly Candon, PhD and Daniel Clauw, MD | Conditions
    • Independent medical practice: Why private clinics are essential

      Marcelo Hochman, MD | Physician
    • How hindsight bias distorts clinical medicine

      Olumuyiwa Bamgbade, MD | Physician
    • Do no harm: Why physician burnout requires bottom-up reform

      Desiree Francis, MD | Physician
    • Institutional distrust in health care: Why a doctor lost faith

      Joshua Mirrer, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Politics and fear have replaced science in U.S. pain management [PODCAST]

      The Podcast by KevinMD | Podcast
    • Evidence-based medicine vs. clinical judgment: a medical student’s perspective

      Jay Pendyala | Education
    • The controversy over Maintenance of Certification for grandfathered physicians

      Bernard Leo Remakus, MD | Physician
    • How hindsight bias distorts clinical medicine

      Olumuyiwa Bamgbade, MD | Physician
    • When side effects are actually a cry for help with medication costs

      Shuchita Gupta, MD | Physician
    • The hidden math behind physician hiring costs and recruitment

      Timothy Lesaca, MD | Physician
  • Past 6 Months

    • The dangers of vertical integration in health care

      Stephanie Waggel, MD | Policy
    • Why does sex work seem like a more viable path than medicine in 2026?

      Corina Fratila, MD | Physician
    • The 9 laws of health care quality: Why metrics miss the point

      Constantine Ioannou, MD | Physician
    • Politics and fear have replaced science in U.S. pain management [PODCAST]

      The Podcast by KevinMD | Podcast
    • From Singapore to Canada: a blueprint for primary care transformation

      Ivy Oandasan, MD | Policy
    • How board certification fuels the physician shortage crisis

      Brian Hudes, MD | Physician
  • Recent Posts

    • Why measuring muscle mass matters more than tracking your weight [PODCAST]

      The Podcast by KevinMD | Podcast
    • Health insurance incentives and alternatives to opioids for chronic pain

      Molly Candon, PhD and Daniel Clauw, MD | Conditions
    • Independent medical practice: Why private clinics are essential

      Marcelo Hochman, MD | Physician
    • How hindsight bias distorts clinical medicine

      Olumuyiwa Bamgbade, MD | Physician
    • Do no harm: Why physician burnout requires bottom-up reform

      Desiree Francis, MD | Physician
    • Institutional distrust in health care: Why a doctor lost faith

      Joshua Mirrer, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The stoic cure for modern anxiety
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...